Tacking tool and tack

ABSTRACT

A surgical tacking apparatus for forming and applying surgical fasteners during laparoscopic or endoscopic procedures is disclosed. It includes a housing having a handle, an elongated tubular portion extending from the housing, a wire advancer, and a wire shaping nose at its distal end. An annular fastener is also disclosed.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority from and the benefits of U.S.provisional application No. 60/373,710 filed on Apr. 17, 2002.

BACKGROUND

1. Technical Field

The present disclosure relates generally to surgical apparatus forfastening objects to body tissue and, more particularly, to a surgicaltacking tool configured to apply a loop fastener to a surgical mesh andunderlying tissue during surgical procedures to repair body tissue, suchas hernia repair.

2. Background of Related Art

A number of surgical procedures require instruments that are capable ofapplying a surgical fastener to tissue in order to form tissueconnections or to secure objects to tissue. For example, during herniarepair it is often desirable to fasten a surgical mesh to the underlyingbody tissue. In certain hernias, such as direct or indirect inguinalhernias, a part of the intestine protrudes through a defect or anopening in the supporting abdominal wall to form a hernial sac. Theopening can be repaired using an open surgery procedure in which arelatively large incision is made in the patient and the hernia isclosed off outside the abdominal wall by suturing. Alternatively, a meshis attached with sutures over the opening to provide reinforcement.

Less invasive surgical procedures are currently available for herniarepair. In laparoscopic procedures, surgery is performed in the abdomenthrough a small incision, while in endoscopic procedures surgery isperformed through narrow endoscopic tubes inserted through smallincisions in the body. Laparoscopic and endoscopic procedures generallyrequire long and narrow instruments capable of reaching deep within thebody and configured to form a seal with the incision or tube throughwhich they are inserted.

Currently, endoscopic techniques for hernia repair utilize fasteners,such as surgical staples or clips, to secure the mesh to the tissue inorder to provide reinforcement to the repair and in order to providestructure for encouragement of tissue ingrowth. These staples or clipsneed to be compressed against the tissue and mesh in order to secure thetwo together thereby requiring a tool which is positioned on each sideof the mesh and tissue in order to deform the staple or clip. Anothertype of fastener suited for use in affixing mesh to tissue, duringprocedures such as hernia repair, is a coil fastener having a helicallycoiled body portion terminating in a tissue penetrating tip, whichhelical fastener is screwed into the mesh and body tissue. An example ofthis type of fastener is disclosed in U.S. Pat. No. 5,258,000. Thus, theneed exists for an improved surgical fastening apparatus that applies afastener to surgical mesh and body tissue for effectively securing themesh to the body tissue.

It is an object of the present disclosure to provide a tacking tool forsecuring a tack to both surgical mesh and body tissue.

Another object of the present disclosure is to provide a tacking toolthat can apply a tack linearly to both surgical mesh and body tissue.

SUMMARY

This invention is directed to a tacking apparatus for applying fastenersto body tissue that includes a housing, an actuation mechanism, a supplyof an elongated wire, an elongated tubular portion having a proximal endand a distal end, the proximal end being in communication with thehousing, and the distal end having a nose having an interior portionadapted for shaping a length of the wire into an annular shape, a wireadvancer for advancing the wire from the supply to and through the noseportion of the elongated tubular portion, the wire advancer beingactuated by the actuation mechanism and cooperable with the wire shapingportion of the nose to shape the length of the wire into a annularshape, and a cutter for severing the annular shaped portion of the wireto form an annular fastener. The actuation mechanism can include atrigger operatively coupled to the housing. In one preferred embodiment,the interior portion of the nose can be concavely curved or may have asemi-circular configuration. The fastener can have a body that issubstantially planar. The interior portion of the nose can be shaped toprovide a fastener with an inwardly disposed end, and an outwardlydisposed end that overlaps the inwardly disposed end. The cutter may beoperatively coupled to the actuation mechanism, it can be adapted toprovide the inwardly disposed end of the fastener with a sharp tip, andit may be adapted to sever the length of wire at or near the distal endof the nose of the tubular portion, to thereby form the annularfastener. Further still, the supply of wire can be a spool having anendless length of the wire wound thereon for providing a multitude offasteners. The wire can be formed from a shape memory material. Thetubular portion can be adapted to fit through a body incision for alaparoscopic procedure. The nose can include a divider having a channelto pass the wire to the shaping portion in the nose.

The invention is also directed to a tack for fastening surgical mesh tobody tissue. The tack can include a biocompatible substantially planarannular wire body, the body having a first end and a second end, thefirst end being disposed inwardly of the second end and having a tipsuitable for penetrating body tissue, and the second end being disposedoutwardly of and overlapping the first end. The first end of the tackmay be sharpened. In another embodiment of the tack, the wire may beformed from either a shape memory material or a bioabsorbable material.

BRIEF DESCRIPTION OF THE DRAWINGS

By way of example only, preferred embodiments of the disclosure will bedescribed with reference to the accompanying drawings, in which:

FIG. 1 is a perspective view of a preferred embodiment of a surgicaltacking tool according to the present disclosure;

FIG. 2 is an enlarged perspective view of the distal tip of the surgicaltacking tool shown in FIG. 1;

FIG. 3 is a cross-sectional side elevational view with portions brokenaway as would be taken through a portion of the surgical tacking tool ofFIG. 1;

FIG. 4 is a front elevational view of a wire ring formed by the surgicaltacking tool shown in FIG. 1;

FIG. 5 is a side elevational view of the wire ring shown in FIG. 4; and

FIG. 6 is a perspective view of an alternative embodiment of a housingportion for a surgical tacking tool in accordance with the presentdisclosure.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Referring now in detail to FIGS. 1-3, in which like reference numeralsidentify similar or identical elements, a surgical tacking apparatus ortool in accordance with the present disclosure is generally designatedas 100. As used herein, the term “distal” refers to that portion of thetool, or component thereof which is further from the user while the term“proximal” refers to that portion of the tool or component thereof whichis closer to the user.

Tacking tool 100 is configured to apply a ring fastener to tissue or tosecure surgical mesh to tissue during surgical procedures such as herniarepair. Tacking tool 100 generally includes a housing 102 including ahandle portion 104 extending from the housing 102. Tacking tool 100includes an actuation mechanism, e.g. a trigger 106 pivotally connectedto housing 102, with a free end of trigger 106 being spaced from a freeend of handle 104. Tacking tool 100 also includes an elongated tubularportion 108 extending distally from housing 102. Elongated tubularportion 108 is preferably dimensioned to fit through conventionallaparoscopic incisions and respective 15 mm, 10 mm, and 5 mm trocarcannula structures. As seen in FIG. 2, a distal end 107 of the tubularportion 108 is provided with a hollow down turned semi-circular orarcuate nose 110 oriented along the longitudinal axis of tubular portion108. Nose 110 preferably includes a divider 112 defining a channel 114therethrough for channeling wire 132 to nose 110 (see FIG. 3).

Turning now to FIG. 3, the internal structure of elongated tubularportion 108 is shown in detail. Elongated tubular portion 108 includes areciprocable wire advancer 116 internally disposed therewithin. Wireadvancer 116 includes an elongated shaft, here shown as having asubstantially circular body portion with an elongated flattened, orotherwise shaped surface portion 118 that defines a passage 120 betweenan inner surface of tubular portion 108 and wire advancer 116. Wireadvancer 116 includes structure for engaging and distally advancing wire134, for example a plurality of teeth 122 formed along the periphery ofwire advancer 116, preferably distally of flattened surface portion 118.While it is preferred that teeth 122 are formed near the distal end ofwire advancer 116, it is envisioned that teeth 122 can be formed at anysuitable location on or along wire advancer 116. The wire may beadvanced by other gripping or friction enhancing structures. Thesestructures can be static, movable, rotatable, ratchet-like, indexing,etc. Preferably, wire advancer 116 is provided with a chamber 124preferably in substantial transverse alignment with teeth 122, chamber124 being opened along a side radially opposite to flattened surface 118of wire advancer 116. Chamber 124 defines an elongated centrallydisposed camming surface 126 that is more deeply internally or centrallydisposed within wire advancer 116 near the surface's distal end and thanits proximal end. A bearing structure 128 is disposed within chamber124. Bearing structure 128 is sized to contact camming surface 126 nearits distal end and to contact the inner surface of tubular portion 108.In this manner, as wire advancer 116 is advanced through elongatedtubular portion 108, camming surface 126 rides along bearing structure128 thereby pressing advancer 116 and teeth 122 oppositely, radiallyoutward toward the inner surface of tubular portion 108. Althoughchamber 124 of this embodiment is shown disposed substantiallytransversely aligned with teeth 122, it is envisioned that chamber 124can be formed at any suitable location along the length of wire advancer116 to effect engagement and advancement of wire 134. In addition, whilea ball-like bearing structure is shown which is free to rotatelongitudinally distally and proximally, it is envisioned that any shapedbearing structure, fixed or relatively moveable, can be employed

Elongated tubular portion 108 includes a cutter. Preferably, wireadvancer 116 includes the cutter, 130, extending distally therefrom.Cutter 130 is configured and adapted for slidable engagement preferablyalong an elongated surface of divider 112 as wire advancer 116 isadvanced distally through tubular portion 108. FIG. 3 shows wireadvancer 116 in a proximal position. As cutter 130 moves distally alongthe distal end portion of divider 112, at or adjacent down turned nose110 of tubular portion 108, cutter 130 shears through wire 134,preferably where or near where it projects out of channel 114.Preferably, the shearing action forms a distal end 146 that facilitatesease of entry into the tissue. Preferably, distal end 146 is sharpened.

Tacking tool 100 includes a replaceable wire source or supply, hereshown as wire spool 132 located within handle portion 104 andoperatively coupled to wire advancer 116. Wire spool 132 is providedwith a straight “endless” surgical grade wire 134 wound thereon. By“endless” it is meant that wire 134 has ends, but is very long toprovide a multitude of fasteners without replacing wire spool 132. Wire134 is threaded through tubular portion 108 by passing wire 134 throughpassage 120, over teeth 122, preferably at least into channel 114. Fromthere, prior to use, wire 134 can be advanced further into channel 114,and prior to or even with the edge of nose 110 of tubular portion 108.In operation, wire advancer 116 is moved distally through tubularportion 108, such that camming surface 126 rides along bearing surface128 and causes teeth 120 to grip wire 134, thereby advancing a selectedportion or length of wire 134 through tubular portion 108 and outthrough nose 110. As wire 134 is advanced along and out of nose 110, theinterior concave portion 109 of nose 110, deforms wire 134 and causes itto turn arcuately 360° or more in onto itself forming an annularfastener, here shown as a wire loop or ring 136 (FIG. 4). Finally, aswire advancer 116 is advanced to its most distal position, cutter 130shears through wire 134 preferably at or near where it exits channel114, thereby separating wire ring 136 from the remainder of wire 134. Asseen in FIG. 3, prior to or as wire 134 is being advanced, nose 110 oftacking tool 100 is pressed into a suitable surgical mesh 138 and intounderlying tissue 140. Thus, as wire ring 136 is formed, it fastenssurgical mesh 138 to the underlying tissue 140. While wire 134 has beendisclosed as being a straight wire wound on a spool, it is envisionedthat a wire formed from a shape memory material and having a shapememory, e.g. Nitinol, can be used, which shape memory wire willautomatically cause the wire to curve as it is ejected through nose 110of tubular portion 108. If shape memory wire is employed that isrestrained and predetermined to curve and form a ring as it is freedfrom a restraint, a curved nose may not be needed. The same applies if atemperature triggerable shape memory metal is employed and the tackingtool is employed at the triggering temperature, for example, by use ofbody tissue temperature. It will be understood that wire 134 can be madeof any suitable biocompatible material, for example, metals, metalalloys, shape memory or not, and polymeric materials, preferablybioabsorbable.

As shown in FIG. 3, to apply wire ring 136, nose 110 of tubular portion108 is inserted into tissue 140 through mesh 138. Wire 134 is thenadvanced through tubular portion 108 and out of nose 110, beginning theformation of ring 136. As more wire 134 is advanced through nose 110,more of ring 136 is formed. As ring 136 is formed, a first, inwardlydisposed end 146 of wire 134 first penetrates through tissue 140, andfollows an arcuate path as it exits tissue 140, passes into theunderside of surgical mesh 138, and then distally back through surgicalmesh 138 and back into tissue 140, thereby completing the formation ofwire ring 136 and the fastening of mesh 138 to tissue 140.

In a preferred embodiment, one complete squeeze of trigger 106 willresult in the formation of a complete wire ring 136. In order to ensurethat a complete wire ring 136 is formed with the squeezing of trigger106, preferably a latch and pawl mechanism (not shown) is provided inthe handle 102. In operation, as trigger 106 is squeezed wire advancer116 is moved distally through tubular portion 108 thereby commencing theformation of wire ring 136. Once trigger 106 is depressed slightly, thelatch and pawl mechanism is configured to prohibit trigger 106 frombackstroking until trigger 106 has been completely depressed and wirering 136 is completely formed. Upon complete depression of trigger 106,the pawl clears the gear teeth (not shown) and the pawl rotates awayfrom the teeth due to a spring biasing (not shown), thereby allowingtrigger 106 to return to its unsqueezed or undepressed condition.

Upon complete depression of trigger 106, wire advancer 116 travels apredetermined distance through tubular portion 108, causing wire 134 tobe ejected a predetermined amount or length which is substantially equalto the circumference of wire ring 136 thereby resulting in the formationof a complete wire ring 136. Moreover, where trigger 106 is onlypartially depressed, the spring-loaded pawl (not shown) operates to holdtrigger 106 stationary and will continue to function to hold trigger 106stationary until trigger 106 has been completely depressed. In this way,the formation of wire ring 136 into body tissue 140 and surgical mesh138 is controlled so that a single wire ring 136 at a time may becompletely formed and fastened to body tissue 140 and surgical mesh 138.The above arrangement prevents formation of only partly formedfasteners.

In FIGS. 4 and 5, wire ring 136 is further shown and described. Wirering 136 includes a body portion 142 preferably having a first, inwardlydisposed end 146 and a second outwardly disposed trailing end 144. Asseen in FIG. 4, after formation of a complete wire ring 136, sharpenedend 146 underlaps (laps radially inside of) second trailing end 144. Itis envisioned, however, that depending on the radius and extent orlength of curvature of the shaping portion of nose 110 of tubularportion 108, trailing end 144 can be made to overlap leading end 146, orleading end 146 can be made to overlap trailing end 144. As seen in FIG.5, after complete formation, wire ring 136 is substantially planar(i.e., proximal end 144 and distal end 146 lie on the same plane withone another). Further, it is seen in FIG. 5 that wire 134 making up wirering 136 has a circular cross section. However, it is envisioned thatany suitable cross-sectional shape or configuration of the wire can beused to form wire ring 136 although a wire having a cross sectionwithout sharpened edges is preferred in order to eliminate thepossibility of the sharpened edges cutting into the tissue or cuttingthrough the surgical mesh.

Turning now to FIG. 6, an alternative embodiment of a tacking toolaccording to the present disclosure is generally shown as 200. Tackingtool 200 includes a handle or a housing 202 and a tubular portion 204projecting from a distal end thereof. The housing 202 includes a handleportion 206 and a trigger 208 slidably coupled thereto and spaced adistance from the handle portion 206. Housing 202 further includes adual rack and pinion arrangement wherein a pinion 210 is pivotablycoupled to housing 202, a lower rack 212 is pivotably coupled to thetrigger 208 and slidably coupled to the handle portion 206, and an upperrack 214 being slidably coupled to housing 202 and rigidly coupled towire advancer 116 (not shown in FIG. 6, see FIG. 3). In this manner, astrigger 208 is depressed, lower rack 212 is moved proximally therebyrotating pinion 210 counter clockwise which in turn moves upper rack 214and wire advancer 116 distally. Tacking tool 200 forms a wire ring 136in the same manner as tacking tool 100.

Tacking tool 200 can be provided with a spool 232 of wire and a latchand pawl mechanism (not shown), like that employed in tacking tool 100,which limits movement of trigger 208 in a distal direction until acomplete wire ring 136 is formed, at which time the pawl can be releasedand trigger 208 allowed to return to its distalmost position.

It is envisioned that the tacking tools disclosed herein can be adaptedto be activated and operated remotely, for example robotically. In suchinstances, for example, the activation mechanism can be located andoperated from a remote control box. The same can apply to the wiresupply.

It will be understood that various modifications may be made to theembodiments disclosed herein. Therefore, the above description shouldnot be construed as limiting, but merely as an exemplification ofpreferred embodiments. Those skilled in the art will envision othermodifications within the scope and spirit of the claims appended hereto.

1-13. (canceled)
 14. A tack for fastening surgical mesh to body tissue,comprising: a biocompatible substantially planar annular wire body, thebody having a first end and a second end, the first end being disposedinwardly of the second end and having a tip suitable for penetratingbody tissue, and the second end being disposed outwardly of andoverlapping the first end.
 15. The tack of claim 14, wherein the tip ofthe first end is sharpened.
 16. The tack of claim 14, wherein the wireis comprised of a shape memory material.
 17. The tack of claim 14,wherein the wire is comprised of a bioabsorbable material.